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General NPI Number Information
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NPI Number | 1871677880
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Entity Type | Organization
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Legal Business Name | SOUTHERN MEDICAL GROUP
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 601 S VETERANS BLVD
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City | GLENNVILLE
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State | GA
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Zip | 30427-1775
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Country | US
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Telephone | 912-654-0475
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 217
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City | CLAXTON
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State | GA
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Zip | 30417-0217
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Country | US
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Telephone | 912-654-0475
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Fax |
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | KATELYN SATTERFIELD
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Credential |
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Telephone | 912-739-3354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 000461
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License Number State | GA
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